Bromelain: a literature review and discussion of its therapeutic applications

Bromelain: A Literature Review andDiscussion of its Therapeutic ApplicationsGregory S. Kelly, N.D.
Abstract First introduced as a therapeutic compound in 1957, bromelain’s actions include:(1) inhibition of platelet aggregation; (2) fibrinolytic activity; (3) anti-inflammatory action;(4) anti-tumor action; (5) modulation of cytokines and immunity; (6) skin debridementproperties; (7) enhanced absorption of other drugs; (8) mucolytic properties; (9) digestiveassistance; (10) enhanced wound healing; and (11) cardiovascular and circulatoryimprovement. Bromelain is well absorbed orally and available evidence indicates thatit’s therapeutic effects are enhanced with higher doses. Although all of its mechanismsof action are still not completely resolved, it has been demonstrated to be a safe andeffective supplement.(Alt Med Rev 1996;1(4):243-257)
Description
Pineapple has been used as a medicinal plant in several native cultures and bromelain
has been known chemically since 1876. In 1957, bromelain was introduced as a therapeuticcompound when Heinicke found it in high concentrations in pineapple stems.
Bromelain is a general name for a family of sulfhydryl proteolytic enzymes obtained
from Ananas comosus, the pineapple plant. It is usually distinguished as either fruit bromelainor stem bromelain depending on its source, with all commercially available bromelain beingderived from the stem.1 The term bromelain will be used to refer to stem bromelain in theremainder of this article.
Bromelain’s primary component is a sulfhydryl proteolytic fraction. Bromelain also
contains a peroxidase, acid phosphatase, several protease inhibitors, and organically bound cal-cium. When the proteolytic fraction of bromelain is purified and extracted, the result is a potentproteolytic enzyme in vitro; however, this component has been shown to be physiologicallyinactive in vivo for many of the conditions where bromelain has a beneficial effect.2 It appearsthat a great deal of the physiological activity of bromelain is not accounted for in its proteolyticfraction and it is likely that the beneficial effects of bromelain are due to multiple factors, not toone single factor that can be isolated.
To date, eight basic proteolytically active components have been detected in the stem.
The two main components have been labeled F4 and F5. The proteinase considered to be themost active fraction has been designated as F9, which comprises about 2% of the total proteins.It is estimated that 50% of the proteins in F4 and F5 are glycosylated, whereas F9 was found tobe unglycosylated. The optimal pH for the F4 and F5 fractions is between 4.0 and 4.5 and for F9close to a neutral pH.3 The entire extract of bromelain has been shown to exhibit its activity overa pH range of 4.5 to 9.8.4
Alternative Medicine Review ◆ Volume 1, Number 4 ◆ 1996 Page 243
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Figure 1. Bromelain’s Impact on the Kinin System & CoagulationKinin SystemIntrinsic PathwayExtrinsic PathwayCommon PathwayAbsorption and Availability
natural source, different sources can exhibit
variability in their physiological activity, even
the gastrointestinal tract of animals, with up
when their proteolytic activity is the same.
Bromelain is not heat stable so it’s physiologi-
stances detected in the blood after oral admin-
cal activity can be further reduced by improper
istration. The highest concentration of brome-
lain is found in the blood 1 hour after admin-istration; however, its proteolytic activity israpidly deactivated,5 probably by the normalplasma protease controls and serum alpha2-macroglobulin.
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Inflammatory Effects of ArachidonicAcid Metabolites
————————————————————————————
————————————————————————————
vasodilation, inhibit platelet aggregation
thrombin time(PT) and activatedpartial thrombo-
plastin time (APTT) are markedly prolonged.8
used to indicate the activity of bromelain; with
Bromelain’s fibrinolytic activity has been at-
published research varying in the designation
tributed to the enhanced conversion of plas-
utilized. Rorer units (R.U.), gelatin dissolv-
minogen to plasmin, which limits the spread
ing units (G.D.U.), and milk clotting units
of the coagulation process by degrading fi-
sures of activity. One gram of bromelain stan-
dardized to 2000 M.C.U. would be approxi-
as well as indirect actions involving other en-
mately equal to 1 gram with 1200 G.D.U. of
zyme systems in exerting its anti-inflamma-
activity or 8 grams with 100,000 R.U. of ac-
tory effect. Both etodolac and bromelain in-
hibit the inflammatory pain in rats in a dose-dependent manner.10 Bromelain was the most
Platelet Aggregation, Fibrinolysis and
potent of nine anti-inflammatory substances
Anti-Inflammatory Activity
tested on experimentally-induced edemas inrats;11 while prednisone and bromelain have
been shown to be comparable in their ability
melain prevents aggregation of blood plate-
to reduce inflammation in rats.12 Treatment
lets was reported in 1972. Bromelain was ad-
ministered orally to 20 volunteers with a his-
shown to decrease significantly the heat-
tory of heart attack or stroke, or with high
evoked immunoreactive substance P release
platelet aggregation values. Bromelain de-
creased aggregation of blood platelets in 17of the subjects and normalized values in 8 of
Mechanism of Action
the 9 subjects who previously had high aggre-gation values.6 In vitro studies have demon-
strated that bromelain inhibits platelet aggre-
lets, activates the kinin system and the clot-
gation stimulated by ADP or epinephrine, as
ting cascade by stimulating the conversion of
well as by prostaglandin precursors, in a dose-
Hageman factor to an active protease (factor
XIIa). Factor XIIa then activates the kinin sys-
tem by converting plasma prekallikrein into
agent in vitro and in vivo; however, its effect
kallikrein, and continues the intrinsic path of
is more evident in purified fibrinogen solutions
the clotting cascade by converting factor XI
than in plasma. This is probably due to the
to its active form. Kallikrein, in an autocata-
antiproteases present in plasma. A dose-depen-
lytic loop, accelerates the activation of
Alternative Medicine Review ◆ Volume 1, Number 4 ◆ 1996 Page 245
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Bromelain’s Impact on Selected Mediatorsof Acute Inflammation
————————————————————————————
————————————————————————————
brinogen to fibrin (seeFigure 1). Fibrin then
determine the effects ofbromelain on the plasmakallikrein system, bradykinin levels and
plasma exudation at the inflammatory site were
cascade.16 This indicates that bromelain’s
examined in rats. Bromelain (5 and 7.5 mg/
action is in part a result of inhibiting the
generation of bradykinin at the inflammatory
bradykinin levels at the inflammatory site and
site via depletion of the plasma kallikrein
a parallel decrease of the prekallikrein levels
system, as well as limiting the formation of
in sera. Plasma exudation was also reduced
activity in sera was elevated after treatment
significant reduction in pain and edema, as
with bromelain, although it was unchanged in
well as enhanced circulation to the injured site.
the pouch fluid.14 The levels of high molecular
weight (HMW) kininogen and pre-kallikrein
repair begins with the conversion of plasmi-
in rat plasma were markedly reduced after
nogen to plasmin, which then acts to degrade
single injection of bromelain (10 mg/kg, i.v.)
fibrin into smaller components which can be
and gradually recovered over a 72 hour period.
rats, bromelain has been shown to stimulate
the conversion of plasminogen to plasmin, re-
sulting in increased fibrinolysis. This mini-
mizes venous stasis, facilitates drainage, in-
reduction in Factor X and prothrombin, both
creases permeability and restores the tissue’s
of which are needed for the activation of
Page 246 Alternative Medicine Review ◆ Volume 1, Number 4 ◆ 1996
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CELL MEMBRANEFigure 2. Bromelain’s Proposed Effect on Prostaglandin Synthesis.
prostaglandins, PGI2 and PGE2 over throm-
may also be due to its ability to selectively
modulate the biosynthesis of thromboxanes
inhibit cyclooxygenase, which is required for
prostaglandins with opposite actions which
the synthesis of series 2 prostaglandins, result-
ultimately influence activation of cyclic-3,5-
ing in a decrease in both pro and anti-inflam-
adenosine (cAMP), an important cell-growth
matory prostaglandins. Rather than blocking
the arachidonic acid cascade at the enzyme
cyclooxygenase, like NSAIDs, bromelain may
or thrombin to platelets activates the enzymes
selectively decrease thromboxane generation
phospholipase C and phospholipase A2 which
prostacyclin (PGI2) in favor of prostacyclin
(see Figure 2). Bromelain, similar to NSAIDs,
has been shown to inhibit PGE2, however, its
action is significantly weaker.16 Table 2 lists
bromelain’s impact on selected mediators of
plasmin by the oral administration of brome-lain, has been shown to inhibit the release of
Antitumor
arachidonic acid from cell membranes, result-
ing in decreased platelet aggregation and
melain on cancer patients was in 1972. Twelve
modulation of the series 2 prostaglandins.17 It
patients with ovarian and breast tumors were
is also hypothesized that bromelain therapy
given 600 mg of bromelain daily for from 6
leads to a relative increase of the endogenous
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Table 3 Selected Cytokines and their physiological activities——————————————————————————————Cytokine
——————————————————————————————Interleukin-1
induces proliferation of fibroblastsincreases leukocyte adhesion, synthesis of PGI2 and
stimulates production of collagenases and increases
increases acute phase responses; including
fever induction, slow wave sleep,neutrophilia, hemodynamic effects, decreasingappetite and increasing synthesis of acutephase proteins
activates resting T cells and macrophagesstimulates ACTH and glucocorticoid releasestimulates synthesis of IL-2 and IFN-gammaincreases NK cell activity
induces proliferation of fibroblastsincreases leukocyte adhesion, synthesis of PGI2 and
stimulates production of collagenases and increases
increases acute phase responses; including
fever induction, slow wave sleep,neutrophilia, hemodynamic effects, decreasingappetite and increasing synthesis of acutephase proteins
cytotoxic to some tumor cellssimilar actions as IL-1 on T cells and macrophagesinhibits lipoprotein lipaseinhibits hematapoetic stem cells
enhances maturation of activated T and B cellsinhibits growth of fibroblastsstimulates growth of hematopoetic progenitor cells
activates macrophagesinduces expression of HLA class II moleculesantiviral activityactivates endothelial cellssuppresses hematopoetic progenitor cells
Page 248 Alternative Medicine Review ◆ Volume 1, Number 4 ◆ 1996
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months to several years, with reported resolu-
Immunity
tion of some of the cancerous masses and a
decrease in metastasis.19 Bromelain in doses
T-cell CD44 molecules from lymphocytes and
of over 1000 mg daily has been combined with
to affect T-cell activation. The highly purified
bromelain protease F9 was tested on the ad-
vincristine, and has been reported to result in
hesion of peripheral blood lymphocytes (PBL)
to human umbilical vein endothelial cells
tastasis of Lewis lung cancer cells implanted
reduced the expression of CD44, but F9 was
about 10 times more active than bromelain;
antimetastatic potential was demonstrated by
having about 97% inhibition of CD44 expres-
both the active and inactive bromelain, with
sion. The results indicate that F9 selectively
or without proteolytic and anticoagulant prop-
decreases the CD44 mediated binding of PBL
Cytokine InductionDebridement
response depends on T cells and macrophages,
(35% bromelain in a lipid base) can be benefi-
along with the polypeptide factors they pro-
cial in the elimination of burn debris and in
duce, called cytokines, which play a key role
acceleration of healing. A non-proteolytic
in communication during normal immunologi-
component of bromelain is responsible for this
cal response as well as infectious, inflamma-
tory, and neoplastic disease states. Table 3 lists
escharase, has no hydrolytic enzyme activity
against normal protein substrates or various
glycosaminoglycan substrates and its activity
varies greatly from preparation to preparation.27
mononuclear cells. Treatment leads to the
plete debridement on experimental burns in
production of tumor necrosis factor-alpha
rats in an average of 1.9 days as compared to
(TNF-alpha), interleukin-1-beta (IL-1 beta),
collagenase, which required an average of 10.6
and interleukin-6 (IL-6) in a time and dose-
the interface with living tissue. It is hypoth-
which had no effect alone, synergistically
esized that bromelain activates collagenase in
increased TNF-alpha production when applied
living tissue which then attacks the denatured
together with the enzymes.23,24 The tryptic but
collagen in the eschar. This produces a demar-
not the autolytic fractions of papain and
cation between living and dead tissue. With
very little scraping, using a tongue depressor,
inducing capacity for TNF production than the
all of the eschar can be removed and a bed
untreated enzyme.25 Trypsin alone had only a
suitable for grafting results. By using brome-
lain, grafting can occur as soon as 24 hours
after the accident. Utilizing bromelain cream
tion may explain the antitumor effects ob-
in the treatment of burns usually results in
served after oral administration of polyenzyme
minimal or no scar tissue formation.Alternative Medicine Review ◆ Volume 1, Number 4 ◆ 1996 Page 249
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administered four times a day along with the
in frostbite eschar removal was extrapolated
following antibiotics either alone or in com-
and investigated. In the initial trial, no debri-
bination; penicillin, chloramphenicol, eryth-
dement other than that of the superficial lay-
romycin or novobiacin. A control group of 56
ers of the eschar was noted. Although third
patients was treated with antibiotics alone. Of
degree burn injuries debrided to a graftable bed
the 23 patients who had been unsuccessfully
after two topical applications of bromelain,
treated with antibiotics, 22 responded favor-
frostbite injuries remained unaffected.29
ably to the combined treatment. In every dis-ease state studied there was a significant re-
Potentiation of Antibiotics
duction in morbidity when the combination ofbromelain and antibiotics was used as opposed
Antibiotic potentiation is one of the pri-
to antibiotics alone. Another group of 106
mary uses of bromelain in several foreign
cases was treated with bromelain alone, with
countries. Bromelain can modify the perme-
results comparable to those obtained with an-
ability of organs and tissues to different drugs.
It prolongs sleeping time in mice administered
pentobarbital30 and increases spinal levels of
tis were placed on standard therapy, which in-
penicillin and gentamycin in rats. In humans,
cluded antihistamines and analgesic agents,
bromelain has been documented to increase
along with antibiotics if indicated. Twenty
blood and urine levels of antibiotics16 and re-
three of the patients received bromelain four
sults in higher blood and tissue levels of tetra-
times daily, while the remaining 25 received a
cycline and amoxycillin when they are admin-
placebo. Of the patients receiving bromelain,
83% had complete resolution of nasal mucosal
inflammation compared with only 52% in the
bromelain concurrently with amoxycillin or
placebo group. Improvement in breathing oc-
tetracyclin resulted in increased serum levels
curred in 78% of those receiving bromelain as
and concentrations of both antibiotics in uterus,
compared to 68% in those receiving placebo.
ovarian tubes, and ovaries as compared with
In the patients not receiving antibiotic treat-
controls. This effect was not generated by in-
ment, 85% of patients receiving bromelain had
domethacin, an anti-inflammatory drug which
complete resolution of inflammation of the
acts as a cyclooxygenase inhibitor, which in-
dicates that bromelain has some undetermined
breathing difficulties. Only 40% of the placebo
activity that enhances absorption and tissue
group had a similar outcome with respect to
distribution of antibiotics.32 A three-fold in-
inflammation, while 53% reported resolution
crease in the level of tetracycline in serum af-
ter oral ingestion of 540 mg of enterically-
coated bromelain has also been demonstrated
other medicines by bromelain may be due to
enhanced absorption, as well as increased
permeability of the diseased tissue which
therapy was instituted for 53 hospitalized pa-
enhances the access of the antibiotic to the
tients with the following conditions; pneumo-
site of the infection. It is also thought that
nia, bronchitis, cutaneous staphylococcus in-
the use of bromelain may provide a similar
fection, thrombophlebitis, cellulitis, pyelone-
access to specific and non-specific compo-
phritis and perirectal and rectal abscesses.
Twenty three of the patients had been on anti-
enhancing the body’s utilization of its own
biotic therapy without success. Bromelain was
Page 250 Alternative Medicine Review ◆ Volume 1, Number 4 ◆ 1996
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Mucolytic Properties
gastric ulcers in experimental animals.40 In an
melain or papain, to remove excessive cervi-
extensive study of the effect of bromelain on
cal mucus was demonstrated in 1954. Obser-
the gastric mucosa, it was found that brome-
vations following its use demonstrated that
lain increased the uptake of radioactive sulfur
pseudo and actual space-occupying lesions
could be more positively identified, and in-
creased uptake of these substances may allow
flammatory changes of the canal and its glands
the gastric mucosa to heal more rapidly under
could be visualized with greater accuracy.36
consistency were investigated in vitro and in
fect of bromelain on enterotoxin receptor ac-
vivo. Of the enzymes tested, bromelain exerted
tivity in porcine small intestine, orally admin-
the most potent lowering effect on sputum vis-
istered bromelain inhibited enterotoxin attach-
cosity and also showed a tendency to increase
ment to pig small intestine in a dose-depen-
dent manner. Attachment was negligible after
treatment. Serum biochemical analysis and
histopathological examination of treated pig-
lets showed no adverse effects with the bro-
bronchiectasis, or pulmonary abscess, those
melain treatment. Administration of bromelain
receiving bromelain orally showed a decrease
may therefore be useful for preventing entero-
in the volume and purulence of the sputum.17
These results support the effectiveness ofbromelain in decreasing the viscosity of
Surgical Procedures and
sputum so that it can be more easily cleared
Musculoskeletal Injuries
in the treatment of inflammation and soft tis-
Digestive Aid
sue injuries. An early clinical trial on brome-
lain was conducted on 74 boxers with bruises
as a digestive enzyme following pancreatec-
on the face and haematomas of the orbits, lips,
tomy, in cases of exocrine pancreas insuffi-
ears, chest and arms. Bromelain was given four
ciency and in other intestinal disorders.38 Be-
times a day for 4 days or until all signs of bruis-
cause of its wide pH range, bromelain has ac-
ing had disappeared. A control group of 72
tivity in the stomach as well as the small in-
boxers were given a placebo. In 58 of the box-
testine. It has also been shown to be an ad-
ers taking bromelain, all signs of bruising
equate replacement for pepsin and trypsin in
cleared completely in four days, with the re-
cases of deficiency. The combination of ox
maining 16 requiring 8-10 days for complete
bile, pancreatin and bromelain is effective in
clearance. In the control group, only 10 had
lowering stool fat excretion in patients with
complete clearance within four days, with the
pancreatic steatorrhoea. In addition, this com-
remainder requiring seven to fourteen days for
bination resulted in a gain in weight in most
cases as well as an enhanced subjective feel-
ing of well being. Symptomatic improvement
melain was investigated in traumatically-in-
was also noted in relation to pain, flatulence
duced hindleg edema in rats. After enteral ap-
plication of bromelain a significant reductionof the edema could be observed, however,
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Conditions in which Bromelain hasDocumented Therapeutic Benefits
to 2.0 days, as compared with controls receiv-
ArthritisAthletic and musculoskeletal injuries
gery were given bromelain four times a day
starting 72 hours prior to surgery. At 24 hours
after surgery, 75% of these patients were
evaluated as having mild or no inflammation,
in contrast to only 19% of a group receiving a
placebo. Twenty-four hours after surgery, pain
MaldigestionPancreatic insufficiency and Steatorrhea
was either absent or mild in 38% of brome-
lain-treated patients, as opposed to 13% re-
ceiving placebo. After 72 hours, this increased
to 75% of those in the bromelain group, as
compared to only 38% in the placebo group.45
patients with blunt injuries to the musculosk-eletal system, the efficacy and tolerability of
parenteral application only resulted in a mini-
high-dose bromelain, in addition to the usual
mal therapeutic effect. Although enterally-ap-
therapeutic measures, was investigated. Treat-
plied enzymes are thought to be degraded in
ment with bromelain resulted in a clear reduc-
the gut, the better results were obtained after
tion in all four parameters tested; swelling,
oral administration of bromelain, supporting
pain at rest and during movement, and ten-
the observation that bromelain can be absorbed
by the gut without losing its biological prop-erties.11
Cardiovascular and Circulatory
Fifty-five pre-surgical patients were di-
Applications
vided into two groups. Group one, consisting
of 22 patients, took bromelain four times a dayfor 48-72 hours prior to surgery and contin-
prevents aggregation of human blood plate-
ued for 72 hours after surgery. Group two, con-
lets in vivo and in vitro, prevents or minimizes
sisting of 33 patients, took bromelain starting
the severity of angina pectoris and transcient
on the day of surgery, with the first dose ad-
ischemic attacks (TIA), is useful in the pre-
ministered one hour prior to surgery. Fifty per-
cent of group one and 42.4% of group two had
thrombophlebitis, may break down cholesterol
complete disappearance of pain and inflam-
plaques, and exerts a potent fibrinolytic activ-
mation within 72 hours. Pain and inflamma-
ity. If administered for prolonged time peri-
tion persisted past 72 hours in only one mem-
ods, bromelain also exerts an anti-hyperten-
ber of the group supplemented with brome-
lain for three days prior to surgery, as opposed
to five members of the group that started
bromelain to 14 patients with angina pectoris
supplementation one hour prior to surgery. In
resulted in the disappearance of symptoms in
a separate study, supplementation of brome-
all patients within 4 to 90 days.48 Similar
lain starting 48-72 hours prior to surgery re-
results have been observed in patients taking
duced the average number of days for com-
between 500-700 mg/day of bromelain. After
plete disappearance of pain from 3.5 to 1.5,
and disappearance of inflammation from 6.9
reappear after a variable period of time, often
Page 252 Alternative Medicine Review ◆ Volume 1, Number 4 ◆ 1996
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not been demonstrated in humans at any dos-
coronary infarct after administration of potas-
sium and magnesium orotate along with 120-
enzymes should not be underestimated, for
400 mg of bromelain per day has also been
they cause, in particular, IgE-mediated respi-
ratory allergies of both the immediate type and
the late-phase of immediate type with pre-
acute thrombophlebitis, bromelain, in addition
dominantly respiratory symptoms. Allergy to
to analgesics, was shown to decrease all symp-
bromelain has been reported in workers of a
toms of inflammation; including, pain, edema,
blood-grouping laboratory, and investigation
tenderness, skin temperature, and disability.50
indicates that (1) bromelain is a strong sensi-
tizer, (2) sensitization usually occurs due to
these conditions may be due to its ability to
inhalation and not to ingestion, (3) bromelain
breakdown fibrinous plaques. Bromelain has
allergy is occupationally acquired, and ad-
been shown to dissolve arteriosclerotic plaque
equate precautions are necessary.53 The risk
in rabbit aorta in vivo and in vitro.2 It is likely
of sensitization to enzymes due to inhalation
that bromelain also increases vessel wall
as a result of occupational exposure is very
permeability to oxygen and nutrients while
increasing blood fluidity, both of which aid in
react with the sera in about 28% of personswith IgE allergic response to honeybee
Toxicity, Side Effects and Allergic
venom.55 Bromelain, along with horseradish
Reactions
peroxidase and ascorbate oxidase are recog-nized by the IgE of sera from patients who are
low toxicity, with an LD50 greater than 10g/
kg. Toxicity tests on dogs, with increasing
as a meat tenderizer and to clarify beer, are
levels of bromelain up to 750 mg/kg adminis-
considered as potential ingestive allergens and
tered daily, showed no toxic effects after six
may represent an unrecognized cause of an
months. Dosages of1.5 g/kg/day administered
allergic reaction following a meal. As with
to rats show no carcinogenic or teratogenic ef-
other food substances, a small segment of the
population, particularly those with a sensitiv-
ity to pineapple, may be sensitive to oral
have not been observed. Bromelain supple-
supplementation with bromelain. As contact
allergens, the enzymes play a minor role; how-
have no effect on heart rate or blood pressure;
ever, it is thought that skin testing with iso-
however, increasing doses up to 1840 mg have
lated proteases like bromelain may induce sys-
been shown to increase the heart rate propor-
temic reactions in susceptible individuals, even
tionately. In some cases an increase of up to
80% of the baseline has been reported, whichmay be a result of bromelain’s influence onIL-1 and TNF production. Maximum effectswere seen at 2 hours but some residual effectremained at 24 hours. At doses above 700 mg,palpitations and subjective discomfort havebeen reported. Blood pressure changes have
Alternative Medicine Review ◆ Volume 1, Number 4 ◆ 1996 Page 253
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Table 5. Considerations and Instructions for Prescribing Bromelain
Is there a history of occupational inhalant/skin contact with Bromelain? If yes, consider possibility of allergic reaction.
Does the patient have allergic reactions to bee stings, olive tree pollen orpineapple? If yes, consider possibility of allergic reaction.
Is there a history of heart palpitations? If yes, limit to 460 mg ofbromelain per day.
Dose 4 times per day for best results.
Dosage ranges typically from 500-1000 mg/day with up to 2000 mg/daycommon.
If used pre-surgery or to minimize trauma from sporting activities, beginbromelain supplementation 72 hours prior to event.
Enhances effectiveness of antibiotics and absorption of glucosamine andpossibly bioflavonoids, so supplement in conjunction with these substances.
Best results might be obtained if taken away from food, however, therapeuticefficacy has been demonstrated when bromelain is supplemented prior to orwith meals.Indications for the Use of Bromelain
for supplementation with oral bromelain.
1. It inhibits blood platelet aggregation,
favorably modulates prostaglandin formation
administered prior to a traumatic event, i.e.
physiological action for as long as it is
administered, with no evidence indicating
and improve the action of other substances
when they are administered in combination.
lacking in side effects, so it can be used
without concern in doses from 200 to 2000
stimulate fever and acute phase response, and
its demonstrated ability to increase the heart
4. It is a protein and seems to be as easily
rate, bromelain may assist in generating an
metabolized as other dietary proteins.
Page 254 Alternative Medicine Review ◆ Volume 1, Number 4 ◆ 1996
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Bromelain has a wide range of conditions
fect at doses as low as 160 mg/day, however,
for which it has well documented therapeutic
there is a general consensus among research-
ers that the best results occur when bromelainis given in doses above 500 mg per day and
Dosage and Prescription
that results improve in a dose-dependent man-
Instructions
ner with higher levels of bromelain supplemen-tation. Bromelain has been demonstrated to be
well absorbed after an oral dose and has been
strate an enhanced efficacy of bromelain when
shown to be safe at high doses for prolonged
it is administered between meals. It is gener-
periods of time. For the conditions discussed
in this review, bromelain has shown itself to
away from food unless it is being used as a
digestive aid, because it is believed that other-wise, it will tend to act as a digestive enzymeand its therapeutic benefit may be diminished.References
While this may in fact be the case, the clinical
Rowan AD, Buttle DJ, Barrett AJ. The cysteine
studies conducted on bromelain have not fol-
proteinases of the pineapple plant. Biochem J1990;266:869-875.
Taussig SJ, Nieper HA. Bromelain: its use in
prevention and treatment of cardiovascular
efits in doses as small as 160 mg/day; how-
disease, present status. J IAPM 1979;6:139-
ever, it is thought that, for most conditions,
best results occur starting at a dose of 750-
Harrach T, Eckert K, Schulze-Forster K, et al.
1000 mg/day. Most research on bromelain has
Isolation and partial characterization of basic
been done utilizing divided doses, usually four
proteinases from stem bromelain. J ProteinChem 1995;14:41-52.
per day, and findings indicate that results are
Jeung A. Encyclopedeia of Common Natural
dose-dependent. See table 5 for a summary of
Ingredients Used in Foods, Drugs, andCosmetics. New York, NY: John Wiley &Sons;1980:74-76.Conclusion
White RR, Crawley FE, Vellini M, et al.Bioavailability of 125I bromelain after oral
administration to rats. Biopharm Drug Dispos
of clinical applications for more than 35 years.
Although its mechanisms of action has not
Heinicke RM, Van der Wal M, Yokoyama MM.
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Report for Brighton and Hove Health and Wellbeing Board (HWBB) and Clinical Commissioning Group (CCG) 9.8.13 By John Kapp, 22, Saxon Rd Hove BN3 4LE, 01273 417997, [email protected] CURING THE NHS AND DEPRESSED PATIENTS BY MASS-COMMISSIONING THE MINDFULNESS COURSE The crisis in the NHS is caused by the following factors, which can be solved locally by councillors initiating culture change

Diagnosis,Therapy and Prophylaxis of Fungal DiseasesGuideline vulvovaginal candidosis (2010) of the german society forgynecology and obstetrics, the working group for infections andinfectimmunology in gynecology and obstetrics, the german societyof dermatology, the board of german dermatologists and the germanspeaking mycological societyProf. Dr. med. Werner Mendling, Vivantes – Klinikum im Fr